Martin Daly (Roscommon-Galway, Fianna Fail)

I thank the Minister and her teams from the HSE and the Department of Health for attending and for giving us their report. My comments will be on the issues of capacity, productivity and digitalisation. Insourcing and outsourcing reflect a lack of capacity in our system that is understandable because our population has grown by 1.2 million in the past 20 years. However, the public needs to be reassured that we are building capacity into the future and the money being invested in our health service by the State is getting value for the taxpayer. There are issues around productivity. The witnesses have given some examples. One of the big areas of concern remains the lack of progress in comprehensive digitalisation of the health service, which will be one of the big drivers of productivity.

Where does the issue with the delivery of surgical hubs lie? What are the timeframes involved? What are the budget allocations for that? Are they guaranteed?

On new hospital beds, we have seen the report into the mid west. You cannot blame the public for losing confidence in the Department of Health and the HSE, and us, in the context of the decision-making around what has happened in Limerick. It is simply untenable, going into the future. We need to know how we will expand to meet demand, especially in the mid west but also in the west and north west, and the rest of the country.

We must also consider the law of unintended consequences. With the increase in outsourcing and the application of a common waiting list within the public service, we now have a situation whereby the many people who rely on private health insurance are finding their premiums going up. Up to 50% of our population are affected. Many others who are paying out-of-pocket expenses to private institutions are finding prices going up because the capacity in the private sector has diminished. There seems to be an unequal transactional situation in the private health service. We need to address that because it is a part of our overall capacity.

I am conscious of time so will move finally to the model of primary care. We have paid lip service to primary care to a large extent. Acute services have expanded, as the report mentioned. I realise that primary care was addressed specifically on a previous occasion. However, the expansion of primary care has not been commensurate with the expansion of acute services. With the growth in population and our ageing demographic, acute services will never meet demand unless we have a robust primary care sector. One of the problems is our model of primary care. We need to review what we are doing. The ongoing GP review will be a part of that. We need also to review the terms and conditions and clustering of allied health professions and nursing professions in the community. I understand it is not very attractive for young occupational therapists or physiotherapists to be sent to a centre in a remote rural area on their own without adequate resources and given the travel time. It is not an issue of productivity. I agree with divestment to the regions but we must also consider why young people are not taking up those posts.